New Research by Epidemiologist Tarang Parekh Highlights Social Risk Factors in Healthcare and ASCVD Outcomes

Introduction

In recent years, the importance of social determinants of health (SDOH) in healthcare has gained significant attention as researchers and healthcare professionals have recognized the substantial impact that non-medical factors have on health outcomes. SDOH refers to the conditions in which people are born, grow, live, work, and age, and they include factors such as housing, education, income, social support, and environmental conditions. These social risk factors are now understood to play a critical role in shaping the overall health and well-being of individuals, especially those with chronic conditions such as atherosclerotic cardiovascular disease (ASCVD).

In a landmark study published in the American Journal of Epidemiology, Tarang Parekh, an assistant professor of epidemiology, emphasized the role of social risk factors in healthcare, particularly ASCVD outcomes. This study stands out as one of the first to analyze data from the State Innovation Models (SIM) initiative, a program launched by the Centers for Medicare and Medicaid Services (CMS) in 2013. The SIM initiative was designed to encourage states to develop innovative payment models aimed at improving healthcare delivery and outcomes, with a particular focus on addressing SDOH. Parekh’s research provides valuable insights into how addressing these social determinants can significantly influence healthcare outcomes, particularly for individuals suffering from ASCVD, one of the leading causes of death globally.

New Research by Epidemiologist Tarang Parekh Highlights Social Risk Factors in Healthcare and ASCVD Outcomes

Overview of the Study

The State Innovation Models (SIM) Initiative

The State Innovation Models (SIM) initiative, launched by the Centers for Medicare and Medicaid Services (CMS) in 2013, was designed to foster innovation in healthcare by providing states with financial incentives to develop, test, and implement new payment and service delivery models. At its core, the initiative aimed to transition the healthcare system from a volume-based care model—where providers were compensated based on the quantity of services provided—to a value-based care model, which emphasizes the quality and outcomes of care rather than the sheer number of procedures or visits. This shift was not only expected to lead to better patient outcomes but also to control escalating healthcare costs, a persistent issue in the U.S. healthcare system.

What makes the SIM initiative particularly noteworthy is its recognition of the importance of social determinants of health (SDOH) in shaping overall health outcomes. SDOH encompass a broad range of non-medical factors, such as income, education, housing, food security, employment, and social support systems, that significantly influence individuals’ health and well-being. By addressing these social risk factors, the SIM initiative went beyond the traditional medical model of healthcare delivery, acknowledging that social, economic, and environmental conditions can profoundly impact an individual’s health and healthcare utilization.

Under the SIM initiative, states were provided the flexibility to experiment with a variety of healthcare delivery and payment models. This flexibility allowed states to tailor their approaches to the specific needs of their populations, especially in relation to addressing social determinants. For example, some states might focus on integrating community-based services with traditional healthcare providers to ensure that patients’ social needs, such as housing instability or food insecurity, were addressed alongside their medical needs. Other states might develop payment reforms that incentivize healthcare providers to partner with local organizations to tackle the root causes of poor health, such as poverty or lack of education.

Ultimately, the SIM initiative aimed to achieve several key goals:

Improving population health: By focusing on a holistic view of health that includes social determinants, states could design systems that foster better health outcomes at the population level, especially for vulnerable and underserved groups.
Reducing healthcare disparities: Disparities in healthcare access and outcomes are often tied to social and economic inequalities. By integrating social risk factors into their strategies, SIM-participating states sought to reduce these disparities and ensure more equitable healthcare for all populations.
Promoting efficient use of healthcare resources: Addressing social determinants of health helps prevent costly health complications by addressing root causes of illness, such as poor living conditions or inadequate access to healthy food. By doing so, healthcare systems can allocate resources more efficiently, focusing on prevention rather than costly emergency interventions.

The SIM initiative represented a fundamental shift in thinking about how to structure and deliver healthcare in the United States. By prioritizing value-based care and encouraging the integration of social determinants of health into state healthcare strategies, SIM laid the groundwork for more patient-centered, equitable, and sustainable healthcare systems across the country.

Data and Methodology

In his study, Tarang Parekh utilized data from the State Innovation Models (SIM) initiative to investigate the impact of social determinants of health (SDOH) on atherosclerotic cardiovascular disease (ASCVD) outcomes. The study analyzed data from three states that participated in the SIM initiative—Arkansas, Massachusetts, and Vermont—and compared them with three non-participating states—Florida, Nebraska, and New Mexico. By selecting these states, Parekh ensured a diverse comparison between regions that had implemented innovative healthcare reforms aimed at addressing social factors and those that had not. The data spanned a five-year period, from 2010 to 2015, and focused on adults hospitalized with ASCVD, a condition resulting from the buildup of plaque in the arteries, which restricts blood flow and can lead to serious cardiovascular events such as heart attacks, strokes, and peripheral artery disease. ASCVD is one of the leading causes of morbidity and mortality worldwide, making it a significant target for both clinical and public health interventions.

The State Innovation Models (SIM) Initiative

The SIM initiative, introduced by the Centers for Medicare and Medicaid Services (CMS), was a federal effort to provide financial incentives and technical support to states for the development and testing of innovative payment and service delivery models. These models were designed to improve health outcomes, reduce healthcare costs, and enhance the quality of care by integrating both clinical and non-clinical factors into healthcare strategies. In particular, the initiative encouraged states to focus on the role of SDOH, such as income, education, housing stability, food security, and social support, in influencing health outcomes. States participating in the SIM initiative were required to implement systemic changes in their healthcare delivery systems, aiming to shift from traditional fee-for-service models to value-based care models that prioritize quality, efficiency, and patient outcomes.

Study Focus and Methodology

Parekh’s research primarily focused on whether the states that adopted these innovative healthcare models through SIM saw improvements in the delivery of care and patient outcomes related to ASCVD. One of the key metrics for evaluating this was the use of International Classification of Diseases (ICD) codes to document social determinants of health, which allowed healthcare providers to systematically record non-medical factors influencing patients’ health. The ICD coding system is a standardized method for classifying diseases and a range of health conditions, and newer iterations of this system have incorporated codes that capture social risk factors, such as homelessness, unemployment, and food insecurity.

The study examined hospital records and administrative data for adults who were hospitalized with ASCVD across both SIM and non-SIM states. By focusing on hospitalized patients, the study was able to track critical health outcomes such as readmission rates, complications related to ASCVD, and overall hospital stay duration, all while accounting for the social contexts of these patients. In particular, the research aimed to determine whether the SIM states had improved their ability to capture SDOH information through ICD coding and whether this improved documentation had a measurable impact on the quality of care delivered to ASCVD patients.

Key Objectives

The primary objective of the study was to assess whether the states participating in the SIM initiative showed meaningful improvements in healthcare delivery, with a particular emphasis on documenting and addressing social determinants of health. The study explored whether hospitals and healthcare providers in these states were better equipped to capture social risk factors through ICD codes, which in turn could allow for more holistic and tailored care for patients suffering from ASCVD. By capturing data on factors such as housing instability, access to nutritious food, and social support, healthcare providers in SIM states could theoretically design more effective treatment plans that account for the broader circumstances influencing a patient’s health.

In addition to examining the use of ICD codes for documenting SDOH, Parekh’s research also sought to understand the broader role of social determinants in shaping health outcomes for ASCVD patients. Social determinants are now recognized as key drivers of health disparities, with individuals facing adverse social conditions often experiencing worse health outcomes and reduced access to care. By comparing states that participated in SIM with those that did not, the study aimed to identify whether addressing social determinants through systemic healthcare reforms could lead to improved outcomes for ASCVD patients, such as reduced hospitalization rates, lower mortality, and fewer complications.

Importance of Social Determinants in Healthcare Models

Parekh’s research highlighted the importance of incorporating social risk factors into healthcare delivery models, particularly for chronic conditions like ASCVD, which are heavily influenced by lifestyle and environmental factors. The study emphasized that while traditional healthcare focuses on clinical treatment, non-medical factors such as income, education, housing, and social support are crucial in determining a patient’s ability to manage chronic conditions and adhere to treatment regimens. By capturing and addressing these social determinants, healthcare systems can take a more holistic approach to patient care, leading to better long-term health outcomes.

Furthermore, the research explored how healthcare systems could integrate SDOH into their value-based care models. States participating in the SIM initiative were expected to implement innovative approaches that addressed both medical and social needs, which could help reduce health disparities and improve population health. By comparing SIM states with non-SIM states, Parekh’s study provided valuable insights into the effectiveness of these integrated care models and the potential for broader adoption of SDOH-focused interventions across the healthcare system.

Overall, Parekh’s study underscored the critical role of social determinants of health in shaping health outcomes for ASCVD patients and demonstrated the importance of capturing and addressing these factors within healthcare delivery systems. By focusing on states that participated in the SIM initiative, the research offered evidence that addressing social determinants through innovative care models can lead to improved patient outcomes, particularly for individuals with chronic conditions like ASCVD.

Key Findings

Statistical Improvements in Capturing Social Determinants of Health

One of the most significant findings of Parekh’s research was the statistical improvement in capturing social determinants of health in states participating in the SIM initiative compared to non-participating states. The study found that the use of ICD codes to document social risk factors, such as housing instability, food insecurity, and lack of social support, was more prevalent in the SIM states. This was a notable achievement, as accurately capturing SDOH data is crucial for understanding the full spectrum of factors that influence a patient’s health.

For example, the study revealed that SIM states showed small but statistically significant improvements in recording social determinants of health among Medicare enrollees with ASCVD. This improvement in data collection is important because it allows healthcare providers to have a more comprehensive understanding of their patient’s health needs, which can lead to more targeted interventions and better outcomes.

The Role of Social Determinants in Health Outcomes

Another key finding of the study was the crucial role of social determinants in influencing health outcomes, particularly in patients with ASCVD. Parekh’s research underscored the fact that while clinical care is essential, over 80% of health outcomes are determined by non-clinical factors, including housing, education, income, and access to healthy food. These social determinants have a profound impact on a person’s ability to manage chronic conditions like ASCVD, and they play a significant role in determining health disparities.

For example, individuals living in neighborhoods with limited access to healthy food options or safe spaces for physical activity are more likely to develop risk factors for ASCVD, such as obesity, high blood pressure, and diabetes. Similarly, individuals with unstable housing or inadequate social support may struggle to adhere to treatment plans or access necessary healthcare services, which can worsen their condition. Parekh’s research highlights the importance of addressing these social determinants to improve health outcomes for patients with ASCVD.

Standardization of Data Collection

One of the recommendations of the study was the need for standardized data collection methods to capture social determinants of health more effectively. The research found that while some states have made progress in documenting social risk factors using ICD codes, there is still considerable variability in how this data is collected and used. This lack of standardization can make it difficult to fully understand the impact of social determinants on health outcomes and to design interventions that address these factors.

Parekh’s study advocates for a universal approach to data collection that would allow healthcare providers to systematically record social risk factors and use this information to tailor care to individual patients’ needs. By standardizing the way SDOH data is collected, healthcare systems can gain a more accurate understanding of the social factors that influence health outcomes and develop more effective strategies to address them.

Implications for Healthcare

Addressing Social Determinants for Better Healthcare Outcomes

The findings from Tarang Parekh’s research have important implications for healthcare systems, particularly in terms of addressing social determinants of health. The study demonstrates that addressing social risk factors can lead to better healthcare outcomes for individuals with ASCVD and other chronic conditions. By recognizing that over 80% of health outcomes are influenced by non-clinical factors, healthcare providers can take a more holistic approach to patient care, focusing not only on medical treatment but also on the broader social context in which patients live.

For example, healthcare providers can work with community organizations to address issues such as housing instability, food insecurity, and lack of social support. By doing so, they can help patients manage their chronic conditions more effectively and reduce the risk of complications. Additionally, integrating SDOH into healthcare delivery can help reduce healthcare disparities by ensuring that all patients have access to the resources they need to achieve optimal health outcomes.

The Importance of Integrating Social Risk Factors into Patient Care

One of the key takeaways from Parekh’s research is the importance of integrating social risk factors into patient care strategies. This is particularly relevant in the context of ASCVD, a condition that is heavily influenced by lifestyle and environmental factors. By incorporating social determinants of health into care plans, healthcare providers can develop more personalized interventions that address the root causes of disease and promote long-term health.

For example, a patient with ASCVD who is struggling with housing instability may benefit from interventions that address their housing needs, such as connecting them with housing assistance programs or providing resources to help them secure stable housing. Similarly, a patient who is experiencing food insecurity may benefit from referrals to local food banks or nutrition programs. By addressing these social risk factors, healthcare providers can improve patient outcomes and reduce the burden of chronic disease on the healthcare system.

Challenges Identified

Inconsistencies in Documenting Social Determinants of Health

Despite the progress made in capturing social determinants of health through the use of ICD codes, Parekh’s research identified several challenges in documenting these factors effectively across different healthcare systems. One of the primary challenges is the lack of consistency in how social risk factors are documented. Different healthcare providers may ask different questions about a patient’s social situation, and this variability can lead to incomplete or inaccurate data.

For example, some healthcare providers may ask patients about their housing situation, while others may not. Similarly, some providers may document social risk factors in the medical record, while others may not. This lack of standardization can make it difficult to fully understand the extent to which social determinants are influencing health outcomes and to design interventions that address these factors.

The Need for Standardization in Data Collection

To overcome these challenges, Parekh’s study advocates for the standardization of data collection methods related to social determinants of health. By developing a universal approach to collecting and documenting social risk factors, healthcare providers can ensure that they are capturing comprehensive and accurate data on the social factors that influence patient health. This, in turn, can lead to more effective interventions and improved health outcomes.

For example, standardizing the way that healthcare providers collect information about housing instability, food insecurity, and social support could help identify patients who are at high risk for poor health outcomes and allow providers to intervene earlier. Additionally, standardized data collection could facilitate research on the impact of social determinants on health outcomes, helping to build a stronger evidence base for interventions that address these factors.

Conclusion

In conclusion, Tarang Parekh’s research highlights the critical role that social determinants of health play in shaping health outcomes, particularly for individuals with atherosclerotic cardiovascular disease (ASCVD). By analyzing data from the State Innovation Models (SIM) initiative, the study demonstrates that addressing social risk factors can lead to significant improvements in healthcare delivery and outcomes. The findings emphasize the need for standardized data collection methods to capture social determinants of health more effectively and ensure that healthcare providers have the information they need to address these factors.

The implications of this research are far-reaching. By integrating social risk factors into patient care, healthcare systems can take a more holistic approach to healthcare, addressing the broader social and environmental factors that influence health outcomes. This approach has the potential to reduce health disparities, improve population health, and create a more equitable healthcare system. Ultimately, Parekh’s research underscores the importance of incorporating social determinants of health into healthcare delivery and highlights the need for continued efforts to standardize data collection and address the social factors that contribute to health disparities.